HIV Burden High Among Southern MSM

New analysis offers detailed look at epidemic

by Michael Smith Michael Smith North American Correspondent, MedPage Today
May 18, 2016

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In many places in the U.S., HIV is "hyperendemic" among men who have sex with men, with a prevalence of 15% in 2012.

Note that the analysis shows that in many places -- concentrated in the southern U.S. -- the prevalence was sharply higher.

In many places in the U.S., HIV is "hyperendemic" among men who have sex with men, a new analysis shows.

The analysis suggested that the national prevalence of HIV among men who have sex with men -- including both diagnosed and undiagnosed cases -- was 15% in 2012, according to Eli Rosenberg, PhD, of Emory University in Atlanta, and colleagues.

But their analysis, which for the first time drills down to the county level, shows that in many places -- concentrated in the southern U.S. -- the prevalence was sharply higher.

"This is the first time we've been able to examine the HIV infection burden among men who have sex with men at such a fine level of geography," Rosenberg told reporters in a telephone briefing.

The findings are not entirely surprising -- it has long been known that men who have sex with men have a higher burden of HIV than other population groups and that black men who have sex with men face a still greater risk.

Also, health outcomes in general have long been poor in the South, with HIV prevention also lagging, commented Jonathan Mermin, MD, director of the CDC's Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

But the new analysis, Rosenberg said, should help health officials understand how the HIV epidemic is intersecting with local populations of men who have sex with men, and with local disparities in health systems.

One thing the study showed is that even in less-populous areas, HIV prevalence can be remarkably high, commented Gregorio Millett, MPH, of the HIV/AIDS advocacy group amfAR.

"Gay men are not safe from HIV is most parts of the U.S.," he told reporters. "It is not just a big city issue."

That said, many urban areas have a high prevalence of diagnosed HIV among men who have sex with men, and most of them are in the South, Rosenberg and colleagues found.

They analyzed diagnosed HIV prevalence in what are called metropolitan statistical areas, a government term for a city of at least 50,000 people and its suburbs.

Of the 25 such areas with the highest diagnosed prevalence of HIV among men who have sex with men, 21 were in the South, the investigators found. Rates in those 25 ranged from 19.92 cases per 100 men who have sex with men (in the Los Angeles/Long Beach/Anaheim area) to a whopping 39.49 per 100 (in Jackson, Miss.)

Aside from Jackson, four other urban areas -- Columbia, SC; El Paso, Texas; Augusta, Ga.; and Baton Rouge -- also had diagnosed HIV rates of at least 25% among men who have sex with men.

In six states -- Arkansas, Georgia, Louisiana, Mississippi, South Carolina, and Texas -- more than 15% of men who have sex with men were living with diagnosed HIV infection in 2012, meeting the definition of hyperendemicity. The same was true of the District of Columbia, the investigators found.

The county-by county breakdown also reflected high rates in those urban areas, but several rural counties in the South have diagnosed HIV prevalence rates of at least 20% and a few reach 30%, Rosenberg and colleagues reported.

The study is an "important new piece of the puzzle," Mermin commented, and demonstrates that even where numbers of men who have sex with men are low, their HIV rates can be high.

Rosenberg and colleagues cautioned that, among other things, the reported HIV rates have numerators based on where men lived at diagnosis, while the denominators come from more recent data from the American Community survey. Post-diagnosis migration and diagnosis of nonresidents might have led to mismeasurement.

The study was supported by the Emory Center for AIDS Research, the National Institute on Drug Abuse, and the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

Rosenberg and co-authors disclosed no relevant relationships with industry.

Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

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